Bangladesh currently witnesses 31 deaths in every 1,000 children under the age of five, while 20 die in every 1,000 newborns
Tamanna [not her real name] – a university student in Dhaka, Bangladesh – did not want to miss classes after becoming pregnant with her first child. While carrying her baby to term, she attended her classes and exams diligently.
When Tamanna gave birth to a stillborn, her doctor pointed out that her regular commute to the university amid intense heat may have played a key role in this tragic incident.
Experts say the number of premature births in Bangladesh is also increasing due to the searing temperature during most of the year. It should be noted that back on April 21, 2024, Bangladesh had to shut down educational institutions for seven days to intense heatwaves.
Bangladesh observed World Prematurity Day in this grim backdrop, as elsewhere across the globe, on November 17.
Bangladesh is one of the top countries in premature newborn deaths. Data from the Directorate General of Health Services (DGHS) show that one in every five newborns in the country dies of complications related to premature birth.

Every year, 5.73 lakh premature babies are born in Bangladesh, making up 19.1% of the total births. The mortality rate for premature babies stands at 22% for the under-five age group.
According to the World Health Organization (WHO) definition, babies born alive before 37 weeks during a pregnancy are called preterm or premature babies. They are born with a weight lower than normal – approximately two and a half kilograms.
Premature babies born with low birth weight develop adverse health complications including issues with respiratory system, kidney, metabolic weakness, and low immunity. They also fall behind in physical and intellectual development.
Bangladesh currently witnesses thirty-one deaths in every 1,000 children under the age of five, while twenty die in every 1,000 newborns.
To achieve SDGs [Sustainable Development Goals] by 2030, Bangladesh will have to reduce the under-five mortality rate from thirty-one per 1,000 to 25, and the neonatal mortality rate from 20 to 12 per 1,000.
Climate change: Heatwaves
Even though the average temperature has gone up by one degree Celsius in the past decade, the phenomenon has dire consequences. An increase in the average temperature of one degree Celsius means the increase is several degrees in a single day.
This is causing a serious impact on maternal health.
According to the International Center for Diarrhea Research Bangladesh (icddr,b), nearly 4.88 lakh premature babies are born in Bangladesh every year – the highest number among 103 countries in the world.

Three newborns die every hour in the country due to premature birth and low birth weight.
Research shows that excessive heat has an adverse impact on pregnant mothers. If an expectant mother spends prolonged periods of time in hot temperature, her baby may be born with low birth weight and may even be stillborn.
Speaking to The Climate Watch, Maternal and Child Health Division (MCHD) scientist at Icddr,b Ahmed Ehsanur Rahman said, “The rising temperatures affects the health of an expectant mother in two ways – shock and stress.
“While there has been little discussion regarding maternal health in the past five to ten years, climate change has recently become a hot button issue. At least seventy studies have shown that there is a correlation between temperature and maternal health.”
An analysis of demographic health surveys and weather data collected from fourteen countries corroborated the same findings, Ehsanur added.
Bangladesh ranked 15th out of 163 countries in UNICEF’s Child Climate Risk Index in 2021.
Moreover, a report by UNICEF titled “Protecting Children from Heat Stress” mentions that babies born during high temperatures are 14% more likely to be sick after birth than during winter.
A science journal Nature study titled “A systematic review and meta-analysis of the effects of heat on maternal, fetal and neonatal health” found that for every one degree Celsius increase in temperature, the risk of premature birth increases by 4%, which climbs to 26% during heatwaves.
Research by The Lancet points out that the preterm birth rate in Bangladesh is 16.20% per 100 people, compared to 13% in India and 14.4% in Pakistan.
Bangladesh ranks first among 103 countries in terms of premature birth rate and second among 158 countries in terms of low birth weight. This indicates 1,340 babies are born prematurely in the country every day and fifty-six per hour, which is the highest preterm birth rate in the world.
Heatwave impact on expectant mothers
An intense heatwave occurred in Bangladesh in April and May. During this period, the temperature in some parts of the country climbed to 43 degrees Celsius. Heat waves are becoming longer, more intense, and more frequent because of climate change.
Heat waves are sweeping across the country, including in Dhaka even in September. As temperatures rise, pregnant women, children, and the elderly, as well as marginalized groups, become the most affected.
Women face physical and psychological changes during pregnancy, and this is why heatwaves have an elevated negative impact on them.
In addition to feeling uncomfortable due to excessive heatwaves and heat, dehydration can also occur, which increases the chances of premature birth and low birth weight of the baby.
Ratna Das, who lives in a tin-shed house in the capital’s Mirpur-14 Bhashantek area, had conceived six months ago, but her baby was born with low birth weight.
Sharing her experience, Ratna said, “I had to deliver my baby before the due date. Around a month ago, my delivery pain started. The doctor had asked for a cesarean section, but we did not have that kind of money.
“After delivery, the baby weighed 1,800 grams. I had to stay in the hospital for a few days.”
Sahina Khatun, another mother living in the city’s densely populated Mirpur-1 Paikpara area, faced the same situation, saying, “My baby was born prematurely, and had several health complications due to being underweight.”
Addressing the issue, icddr,b scientist Ehsanur said, “Severe heatwaves are one of the key reasons behind pregnant mothers giving birth to premature babies. An expectant mother’s body temperature is already higher than that of a normal person because she is carrying her baby.
“As a result, excess heat from the outside, especially during a heatwave, can cause preeclampsia [a problem caused by high blood pressure], premature birth, and even stillbirth if the pregnancy lasts less than 28 weeks.”
As the average temperature in Bangladesh continues to go up due to climate change, heat stress increases the risk of pregnant mothers suffering from preeclampsia, which in turn is causing the number of premature births and stillbirths to rise.
This impact of extreme heat is even more severe in Bangladesh, which is home to a mostly middle and low-income population.
Heatwaves & premature birth
According to UNICEF, if the temperature increases by 1 degree Celsius, the chance of premature birth in pregnant women increases by 5 percent. This risk increases by 16 percent on days with extreme heat compared to normal hot days. This triggers premature births.
Recent estimates by UNICEF further show that 35.5 million children in Bangladesh – which is 99% of the total child population at the time – will face severe heatwaves in 2050 due to the impacts of climate change.
There will be an average of 4.5 or more heatwaves per year in the country. This is a significant increase compared to 2020, when only 2.6 million children – or 5% – faced such risks.
Icddr,b Climate Change and Health Initiative Research Investigator Maheen Al Nahyan said, “After monitoring global warming and climate change indicators, it is clear that some changes in Bangladesh are occurring faster than the global rate, such as temperature increase.
“Bangladesh’s average temperature has increased by around 1 degree Celsius in the last 30 years, showing a temperature increase rate of about 0.3 degrees Celsius per decade. According to projections from various climate models, temperatures could increase by 1.8 degrees Celsius by 2060 and 2.7 degrees Celsius by 2090 compared to 1990.”
According to UNICEF’s 2021 Children’s Climate Risk Index (CCRI), children in Bangladesh are at “extremely high risk” of the impacts of climate change.
The abnormal rise in temperature poses serious risks, especially for newborns, infants and young children who can suffer from heat-related illnesses, such as heatstroke and dehydration, including diarrhea.
Doctors say premature babies face an elevated risk of death, as well as long-term health complications such as cerebral palsy, delayed intellectual development, epilepsy, and even blindness.
Prof Dr Nahrin Akhtar, former chairman of the Department of Feto-Maternal Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), said, “Premature deaths due to asthma, pneumonia, and respiratory problems are usually more common in winter.
“Intense heat causes disruption to embryogenesis (fetal development) in a mother’s womb. A fetus develops in the first 6-8 weeks. Then, various organs of the baby grow and develop. A premature baby born at 37 weeks cannot tolerate outside temperature as a normal baby.”
So, both low and high temperatures are bad for a premature baby, and many are dying soon after birth. If the temperature is low, it can be controlled with special care and kangaroo mother care, but there is no such method in the case of hot temperatures, she added.
Tackling intense heatwaves
Bangladesh observed intense heatwaves from 2017 to 2023, usually from April to August.
In May this year, the DGHS, with the support from UNICEF, published a national guideline to protect vulnerable communities, including children and pregnant women, from heat-related health risks.
According to the guidelines, a temperature of 36 to 37.9 degrees Celsius is considered mild, 38 to 39.9 degrees Celsius is moderate, 40 to 41.9 degrees Celsius is severe, and 42 degrees Celsius or more is a very severe heatwave.
During intense heat, dehydration is the most common ailment, and it can cause serious problems during pregnancy and postpartum period. For example, the amount of water in the uterus may decrease, and milk production may decline. Dehydration can also trigger premature birth.
Another study has shown that premature births are more common in low- and middle-income countries at high temperatures. In addition, hot temperatures are one of the causes of low birth weight.
The number of stillbirths increases 1.05 times for every one-degree Celsius increase in temperature.
In addition, the effects of outdoor temperature and heat during pregnancy can lead to birth defects such as premature birth, low birth weight, miscarriage, and stillbirth, especially in low-income countries.
Dr Halida Hanum Akhtar, a professor at Johns Hopkins University in the United States, a specialist in gynecology and obstetrics, told The Climate Watch, “This issue is more prevalent in villages compared to cities, because the facilities available in rural regions are inadequate.
Also, the Share-Net Bangladesh [a development organization on sexual and reproductive health and rights] steering committee chairperson, Dr Akhtar added, “If a pregnant woman lacks the right climate for the development of her unborn child, then the risk of premature births increases.
“Excessive heat can increase the mother’s mental stress, cause high blood pressure and pregnancy-related complications, cause problems during childbirth, and lead to premature birth.”
Are there any solutions?
Professor Dr Md Abdul Mannan, chairman of the Department of Neonatology at BSMMU, points out that around 25,000 children die in Bangladesh every year due to premature and low birth weight.
Experts say to reduce the premature mortality rate, authorities concerned should boost supervision from grassroots to the center for implementing appropriate policies.
Speaking to The Climate Watch, gynecologist Professor Dr Nahrin Akhtar said, “Although the premature birth rate in Bangladesh has decreased in the last few years, the figure falls far from expectation.
“We must raise awareness on this issue. Expectant mothers should be notified not to go out in intense heat, drink more water, and stay in shaded places.”
Icddr,b scientist Ehsanur said, “Bangladesh should identify a specific heatwave zone, and collect data from there. Moreover, people go to hospitals less during heatwaves. We should launch coordinated research to gather detailed information.
“Heatwave guidelines published by the government must provide special importance to maternal health. The correct implementation of these guidelines will benefit everyone. In the next decade, the temperature in Bangladesh will increase further and there will be frequent heat waves. So, we must take the necessary measures keeping this fact in mind.”
He continued, “There are policies in various countries to tackle extreme heat. In Saudi Arabia, all activities are stopped when the temperature reaches 42 degrees Celsius. Preparations are made a week before a heatwave arrives in London.
“Bangladesh should make plans in line with global practices, such as having adequate ambulances in case of emergency, and training all medical staff to provide first aid in extreme heat.”
Echoing the same, Dr Akhtar said, “We need to be more aware, and keep people informed. Communication is particularly important. Do not let pregnant mothers go out during heatwaves, keep them safe.
“Public awareness should be raised on the correlation between heatwaves and premature birth.”
She added, “The government, service providers, families, parents of the child, everyone has a role to play. This information should reach them. These issues should be included in the guidelines published by the government.
“Besides, health researchers including the icddr,b, Institute of Epidemiology Disease Control and Research (IEDCR), Bangladesh Medical Research Council (BMRC) should conduct more research on the matter. Besides, organizations such as the Obstetrical and Gynaecological Society of Bangladesh (OGSB) should swap crucial information with the government.”